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Higher colorectal cancer screening rates linked to patient-centered medical home access

Higher rates of colorectal cancer screening among primary care patients were associated with exposure to a patient-centered medical home model, according to data published in the Journal of the American Board of Family Medicine.

“The patient-centered medical home (PCMH) has generated national attention as a means of improving evidence-based care, including increasing appropriate uptake of U.S. Preventive Task Force recommended [colorectal cancer screening] tests,” Beverly B. Green, MD, MPH, of the Group Health Research Institute, in Seattle, and colleagues wrote. “The PCMH was designed to replace episodic care based on illness and patient complaints to provide ongoing ‘whole-person’ comprehensive chronic illness and preventive care services. … Observational studies suggest that adoption of the PCMH increases cancer screening rates; the evidence is limited, however, with only one study reporting a change in [colorectal cancer screening] rates.”

To determine the association between PCMH implementation and colorectal cancer screening, the researchers studied both years of the Systems of Support to Improve Colorectal Cancer Screening (SOS) and follow-up trial, which recruited 4,664 patients from 21 Group Health primary care clinics in western Washington from August 2008 to November 2009. Participants were randomly placed into groups that received either usual care, mailed fecal kits, kits plus brief assistance, or kits plus assistance and navigation.

Toward the end of the study, from October 2009 to January 2010, Group Health implemented a PCMH in all its primary care clinics. This, paired with the fact that participant recruitment for the study had been spread out over 16 months, meant some patients had very little exposure to the PCMH model, while others’ entire first year occurred after implementation. The researchers used logistic regression models to analyze the links between PCMH exposure and colorectal cancer screening.

According to the researchers, usual care patients with 8 months or more in the PCMH had higher colorectal cancer screening rates than those exposed to 4 months or less of the model (adjusted difference 10.1%; 95% CI, 5.7-14.6). SOS interventions led to significant increases in colorectal cancer screening. However, the degree of effect was weakened by exposure to the PCMH (P = .01).

“As hypothesized, implementation of the a PCMH team care model that included clinic-based in-reach and outreach was associated with higher [colorectal cancer screening] rates among SOS usual care group participants,” Green and colleagues wrote. “SOS interventions led to significant increases in [colorectal cancer screening] uptake, but the magnitude of the effect was inversely related to the level of PCMH exposure. … Future research could study ways to effectively integrate both programs and further optimize screening rates.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.